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C~AlTH OF PENNSYLVANIA
DE:PARTHl:NT Of REVENUE
IURfAU or INDIVIDUAL TAX[S
tJ(PT. zuni
HARAJSIUAG, PA 17IZI'0'01
*
;.:; ~ fo co?
INFORMATION NOTICE
ANO
TAXPAYER RESPONSE
FILE NO.
ACN
DATE
C/
21-"'1,-(."
95160598
12-20-95
'1'.1141 II an U."I
TYPE
EST. OF WILLIAM H DOUGHERTY
5.5. NO. 189-09-1296
DATE OF DEATH 10-23-95
COUNTY CUMBERLAND
OF ACCOUNT
o SAVINCS
!Xl CHECKINC
o TRUST
o CERTIF.
COLLEEN M POWERS
8 SUSSEX RD
CAMP HILL PA 17011
RE"IT PAY"ENT AND FOR"S TOI
REGISTER OF WILLS
CU~8ERLAND CO COURT HOUSE
CARLISLE, PA 17013
PH( BAHK hu provld.d tM D.p.rt.."t .lth tM lnfor..Uon 1 ht.d b.low which h.. b.en u..d In ulcuhtlna the
potentl.1 t.. due. Their r.cord. Indlc.t. th.t .t t~ d..th of tM .bov. d.C.d.nt, you ..r. . Joint owner/b.neflcl.ry 0' thl, .ccount.
I' you '1.1 thl. In'or..tlon I. Incorr.ct, pl.... obt.in .rltten corr.ctlon 'rol the flnencl.1 In.tltutlon, .tt.ch . copy to thl. for.
end ,..t"r" It tit tM MHIV. ..ckl,..... 'hI. Il("O:rt',"t I. hw~l. In ucordlfW;:1 with the 1"".,,!t3l":c. h:c l!Jw' of thl Co..un....lth u( Penn.,lv"",,,,
Que.lIon. ..., ba ."....r.d by ulllng (717) 7.7.11l7.
COMPLETE PART 1 BELOW . . . SEE REVERSE SIDE FOR FILING AND PAYMENT INSTRUCTIONS
Account No. 5140016963 Oat. 01-01-78
E.tab1hh.d
Account aa1anea 2.074.85
r.rcant T..ab1. X 16.667
~t Subj.ct to T.. 345.82
T.. Rata X .15
Potantlal T.. 0... 51. 87
PART TAXPAYER RESPONSE
[!] I FAILURE TO RESPOND WILL RESULT IN AN OFFICIAL TAX ASSESSMENT BASED, ON THIS, NOTICE
A. c:J The .bOv. Infor..tlon end t.. due I. corr.ct.
1. You ..y choa.. to r..1t p..,.."t to tM R.glttlr of Wlllt with t\lfO copl.. of \hit noUn to obtaIn
. dl.count or .vold Int.rl.t, or you "'1 chick bo. -A- and r.turn thl. notlca to t~ AIGI.tlr of
Will. and ~ offlclll .......ant will ba I..u.d by the PA D....rt.ent of Alvenue.
To In.ure proper cr.dlt to your .ccount, t\lfO
(Z) CoPle. 0' thl. notice .u.t ICcoapany your
p.yaant to the A.glltlr 0' Will.. "aka check
...ylbl, tal ~'II.tlr 0' Wille, Agent-.
HOTE; I' ta. p.yaent. .ra .-dl .Ithln thr.a
(3) -ont", of the decadent" date of de.th,
you uy deduct. 5% dhcCN"It 0' the to due.
Any inheritance t.. duI ",Ill baco.. delinquent
nine (9) ~th. .ftlr the data 0' de.th,
[CHECK ]
ONE
BLOCK
ONLY
s. c:J Thl Ibov. ....t h.. bien or will b. rlPOrted and t.1C p.ld with thl Penn.ylvWlI. INMiritMCI T.. return
to be '11.d by thl d1c.dant', rapr,.entatlvl.
C. (!; The Ibov. In'orAtlon II Incorr.ct and/or debts and d.ductlon, wer. paid by you.
You au,' coapl_tl PART [!] and/or PART [!] balo",.
PART
~
TAX RETURN - COMPUTATION
lINE 1. Data E.tab11.had
2, Account aalance
3. Percent Taxable
4. Aaount Subjoet to Ta.
5. Debt. and Deduction.
6, AMOunt Taxabla
7. Tax Rate
8, T.x Dua
If you indic.ta a diffarent t.x rat., pl.... .tate your
relationship to decadent. f'\rt-L...w..'\-..:-
. I
OF TAX ON JOINT/TRUST ACCOUNTS
1.....Ct-t'.~ l~g:-"ulfU~\t>ciK~
2 L!2l'*' il!:>
3 X It..(.,\> 1
4 1-15'. '01
5 .-0-
6 1-1::'-. '=12..
7 X .cla
e -1I:l.~.,5
DEBTS AND DEDUCTIONS
OFFICIAUUSE ONLY 0 AAF
PA DEPARTMENT OF'REYENUE
PART
~
DATE
PAD
'1
2
3
0\
5;
6
7>
8
CLAIMED
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PAID
PAYEE
DESCRIPTION
AMOUNT PAID
!
TOTAL lEntar on Lina 5 of T.x Co.putation)
perjury, I declare that the facta I
.y knowledge and balief,
I
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HOME
WORK
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GENERAL INFORMATION
1. FAILURE TO RESPOND WILL RESULT IN AN OFFICIAL TAX As.5eSSHENT ..lth IPpllcable Int.,ut bultd on Infor..Uon
,uIMIUted by tM flnww:l.l InltJtutJon.
Z. Inheritance t.. bec~. delinquent nln. .onth. .ft" the dlcadent', data of d..th.
J. A joint ICCount I. t'.abl. .v~ though thl dac~ent'. n... .... ~ '1 . ..tta, of convenlenc..
It, AccounU (Including tho.. tMld blIt...." husbllftd and MU,) which tM dKMtent pUt In Joint n.... IfUhln on. y..' prior to
d..th .r. fully t'.abl, II tr~,'.r..
5. Account. .,tabllshed jointlY between hulbllftd end .,1'. lor. thtn one y..r prior to d..th .r. not l,.able.
,. Iccount. held by . decedent -In trult fa,. enathar or othar. .r. ,...01, fully,
REPORTING INSTRUCTIONS - PART 1
- TAXPAVER RESPONSE
1. BLOCK I - l' tn. Infor..tlon ~ c~t.tlon In the notlcl .r. corrlct and deduction. .r. not baing clal..d, pl~. ~ .~
In block -,- of Pert 1 of the -T..pIYlr Respons.- .actlon. Sign two copl.. and lu~lt tha. with your chack for t~ .-DUnt of
tall to tN R.ght.r of Villi 0' the cCMIty Indlut~. n,a PA aaparbent 0' hv.nua will IIILItI en official .........,t
(For. REV-IS41 EXI upon racalpt 0' the r.turn 'r~ tha R.gl.t.r 0' will..
Z. IlOCX I - If the ....t .pecl,led on thl. notlc. ha. ba~ or will b. rapartad and tIll p.ld with the Pann.ylvanl. Inherltanc.
TIll R.turn ,11.d by the decedent'. rapr..ant,tlv., plac. en ..- In block -.- 0' P.rt I 0' the -l,_p.yar Ra.pon.,- lectlon. Sign one
copy ~ r.turn to the PI Dap.rt.ant of R.venue, &urn" of Indlvldu.l r..... aapt za0601. Harrisburg. PA 11lZI-0601 In 1M
env.lope provlct.d.
5. BLOCK C . If the notlc. Infor..tlon I. Incorrect andlor deduction. Ir. b.lng cl.l.ed, check block -C- end cDlpleta P.rt. Z end 5
.ccorclln" to 'tlM In.trucllons lI,I.,... :J1iI\ t.o c~pJ~. ar.: ..obIIlt th.. wHI". 10ur c."s-:k fer t."c ......-unt 0' ten P'l."~:: ~:I thl "Ichtsr
of WillI 0' th. county Indle.tld. The PI Dap.rt.ant 0' R.v~ will I..ua en o,'lel.1 ......eent (For. REY-IS41 EX) upon racalpt
01 ~ raturn Iroe the Ragl.t.r 01 will..
TAX RETURN - PART 2 - TAX COMPUTATION
LIN[
1. tnt.r the d.t. the account originallY w.. a.tabllthad or tltlad In the .annar ..I.tlng It dlt. 01 d..th.
HOlE I f'or I decedent dylna .ft.r lZ/1UIZI Accounh which the decadent put In joint n... within on. (I) y.ar 01 death arll
tax.ol. fully.. tran,'.r.. However, there I. en ._elu.lon not to ellc..d 11.000 p.r tran.f.r.. raDardll.. 01 the value of
the account or the nuabar of accounh held. .
If . doubl. ..t.rlsk (..) app..r. balor. your flr.t n... In the addr... partlon 01 thl. notlc.. ~ 15,000 'lIclu.lon
.Irllldy hat been dldUctM 'roe thllICCot.a'1t balltlC. II reported by the flnancld In.tltutlon.
Z. Enter the tot.1 balanc. 01 the account Including Inllr..t accrued to the d.t. 0' d..th.
5. The percant 0' the KCOl.&'1t that It tlllabl. lor .ach .urvlvor h cMt.ntlnad II follChlu
I. The parCWlt tax.ol. lor Joint ....t. IIt.olbhad .or. tNn anti ynr prior to the dac:edent'. deathl
1 DIYlDED BY TOTAL fUtlER OF
JOINT DWNER'S
Exe.plal I joint ....t ragl.t.rad
DIVIDED IV TOTAL NUttIER OF X 100 . PERCEHT TAXAILE
Sl.RYIYUC: JOIHT OWNERS
In the "... 01 the dKacMnt It'ld two othar parlon..
1 DIVIDED IY S (JOINT OWNERS) DIVIDED IY Z (SURVIYORS) . .167 X 100 . 16.7X (TAXABLE FDA EACH SURVIVOR)
I. Tha p.rcent t._abla for a..at. cra.tad within on. y..r 01 the dlCad.nt.s d.ath or .ccount. owned by the dacedent but held
In tru.t 'or ~ther IndlvldlAlh) (tru.t bIn.Hehd.s)1
I DIVIDED IV TOTAL HU"IER OF SURVIYINC JOINT
OWNERS DR TRUST IENEFICIARIES
X 100 . PERCENT TAXAILE
ElIaapl'l joint account r.,I.t.r.d In the n... 01 the dec.dent ~ two ather par.an. ~ ..tablllhld within one y.ar 0' daath by
the dacadant.
1 DlVIDED IY Z (SURVlVORS) . .50 X 100 . SOX (TAXAILE FDA EACH SURVIVOR)
4. The.-aunt tubJact to t.1l (line 4) I. dat.r.lned by aultlplylno the ICCount b.lenc. (1In. Z) by the percant t'lIabl. (line 1).
~. Ent.r the total 01 the dabt. and deduction. ll.t.d In p.rt S.
6. The.-aunt ta_abla Ulna 6) It datar.l,*, by .ubtracUnt ~ dabt. and d~tlon. Ulna 51 froe the ~t 'Ubject to tax Uln. 4).
7. Ent.r the approprlat. t.1l r.t. (line 7) .. det.ralned balow.
I. For dat.. of d..th occurrlno ,'t.r 6/30/94, the tax r.t.. far tran.f.r. to spous.. ar. .. follow.:
1. Oat.. 01 de.th on or .ft.r 7/1/94 and b.lor. 1/1/'5 the rata I. 5X.
Z. Data. 01 d..th on or ,'ter 1I119S tr","a,.. to ,pou,,, will be t._ad at OX tall rat..
Notal For dlt.. 0' dI.th prior to 7/1/94 tran".r. to spou", ara ta_abl. .t 6X.
I. lr....,.,.. to lIne.1 d..candant. Includl"l I.tMr, IOther, .on, dauoht.r, grandchlldr.", .on-In-I...,
dluQht.r.ln.l..., .tepchlld and thalr I..ue .ra tallabl. .t .111 parc."t (6X).
C. lrM,'.r. to .11 other. Including broth.r, .I.t.r, unci., eunt. n.ph.w and nlac. ar. t._abl. .t fl,t.." p.rcant (15X).
D. I' JOU change the tlX rata, pl.... .paclly your ralatlonshlp to the dac.dlnt In t~ ar.a provided.
I. lhe.-aunt of tax due Ulna IJ It d.taralnad by ....Itlphlng the MOUnt t.ubl. Cllna 6) by the t.x rat. Uln. 71.
CLAIMED DEDUCTIONS - PART 3
DEBTS AND DEDUCTIONS CLAIMED
Allowabl. debt. and deduction. ara d.tar.lned .. 'ollow.:
A. You I.gally .r. ra.pan.lbl. for payaant, or the ..tat. .ubject to .a.lnl.tratlon by I Plr~l repr..ant.tlv. I. In.ufllcl."t
to pay the deductlbla It....
I. You actually p.ld the dabt. .ft.r daath 0' the d.cadent and can furnl.h proof of p.y.ant.
C. Debt. b.lng clalald au.t be It..lz.d fully In P.rt 1. I' additional .pac. I. needed, u.. ,1.ln pepar I 1/:- II 11-. Prool of
payaant "Y b. r~.t.d bv the PI Dep.rt.ant of A-..nua.
TAXPAYER ASSISTANCE
IF YOU NEED FURTHER INFORMATION OR ASSISTANCE, COMTACT ANY
REGIST~R OF WILLS. PA DEPARTMENT OF REVENUE DISTRICT OFFICE
OR CALL THE BUREAU OF INDIVIDUAL TAXES, TAXPAYER INQUIRY UNIT IN
HARRISBURG AT (717) 787-8327. TDD' (717) 772-2252 (HEARING IMPAIRED ONLY)
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C~AlTH OF PENNSYLVANIA
DEPAATH[HT OF REVENUE
IUREAU OF INDIVIDUAL TAXES
OfP'. ZlUIl
HARAISIURC, Pi l11ZI.0601
*'
/5
INFORMATION NOTICE
AND
TAXPAYER RESPONSE
FILE NO.
ACN
DATE
21-9("~t'l
95160599
12-20-95
....l.....ntnll...1
TYPE
EST, OF WILLIAM H DOUGHERTY
S,S. NO, 189-09-1296
DATE OF DEATH 10-23-95
COUNTY CUMBERLAND
OF
ACCOUNT
IX] SAVINGS
o CHECKING
o TRUST
o CERTIF.
TO,
COLLEEN M POWERS
8 SUSSEX RD
CAMP HILL PA 17011
REHIT PAYHENT AND FORHS
REGISTER OF WILLS
CUMBERLAND CO COURT HOUSE
CARLISLE, PA 17013
..
PHC BANK he. provided tM Depart..,,' ..lth the Infur..tlon lhhd balo.. which hi.. bHn u..d In ulculltlna the
pot~tl.1 t.. due. TMl,. rIcoI'd I Indicate thlt at the d..th of the abovI dleldlnt, you w.,.. . Joint own.r/b~flcl.ry of thl. ICCOunt.
If you ,..1 thl. Infor..tlon I, Incorrlct, pl.... obt,ln written corrlctlon '1'01 thl fln~l.l 1"ltltutlon, attach. copy to thl. for.
and return It to t~ ~V. add,..... Thl, account I, t..~l. In accordanc. with the r~rlt~. Tlx l~w. of the Co..~.lth of P~.ylvanl..
au..tlon. ..y bl In.~r~ by Ctlllng (717J la7-a3Z7.
COMPLETE PART 1 BELOW . . . SEE REVERSE SIDE FOR FILING AND PAYMENT INSTRUCTIONS
Account No. 5130093834 D.t. 01-01-81
Eohh1hhod
To In.ur. proper cradlt to your account, two
(ZJ copl.. 0' thlt noUc. .u.t acco",any YIK'"
pay..nt to tha Aagl.tar 0' wIll.. "aka check
pay~la tal "aal.tar of will., Agent-.
Account 801..... 8,678.B9
P.rcant TOlCoh1. K 16.667
Aoount Subj.ct to T.. 1,446.51
T.. R.t. X .15
Potontlol T.. Duo 216.98
PART TAXPAYER RESPONSE
ITlIF'AXLURE TO RESPONDlllLL JU!SUL,.)IN AN OFFICIAL,TAX ASSESSHEHr' BASED ON THIS HOTICE I
A. 0 The abov. Infor..tion and ta. dt.Mi 11 corrKt.
1. You ny choa.a to ra.lt paYttW1t to tha Aaahtar 0' Willi with two copl.. of thh notic. to obtaIn
. dl.count or avoid Intar..t, or you .ay check bolC "A" and raturn thl. notlc. to the Raal.t.r 0'
WIll. and an o"lclal .......~t will b. I..u.d by the PA Dapartaant 0' R.v.nue.
HOTEl If t.. p.~h .re nde within thr..
(3) aontha 0' the d.cadent'. data 0' daath,
you ..y daduc:t . 5;( dllc~t 0' the tu w..
Any Irhlrltanc::. tu due wIll bac:o.a dallnquant
nine (9J aonth. "t.r the data 0' d.ath.
[CHECK ]
ONE
BLOCK
ONLY
I. 0 Th. above ....t hu b.en or will b. report.d and t.. paid with the Pann.Ylvanla Inherltanc. Tn nturn
to be fllad by the decadent.. r.pre.antatlv..
C. ijJ The abova In'or..tlon I~ncorract and/or d.tJt. and deduction. ware paid by you.
You _ut caplet. PART l!J and/or PAAT (!] balow.
If you indicat. a diffarant tax rat., pl.... .tat. your
ralation.hip to d.cad.nt:
'.,OFFICIAL,' ,USE, O,NLY,,) OAAF
f'A,' DE!YIRTHENT" OI'RE'lENUEc:,;,:
PAU'::,!"'" '~.,-" '-Of.' ...,....;.,,".:,..'...."''"
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CLAIMED
PART
~
TAX RETURN . COMPUTATION
LINE 1. D.t. Eotoh1ioh.d
2. Account Balanca
5. Parcant Taxabl.
4. Aaount Subjact to Tax
5. Debt. and Daduction.
6. Aaount Taxabla
7. Tax Rata
a. Tax Dua
OF TAX ON JOINT ,,'(RUST ACCOUNTS
1."->.... ,~"'-I~'<Lr~.\.to c.G.>.dk
2 'ii ~"'7€l . d4
5 X It,e,.L.'-''
4 \.'i-lla.-;;'
5 -u-
6 l. "i'4lt!. ~ I
7 X .~1O
a 'tic."7'1
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PART
@]
DATE
DEBTS AND DEDUCTIONS
PAID
PAYEE
DESCRIPTION
AMOUNT PAID
I
TOTAL IEnt.r on Line 5 of Tax Co.put.tlon)
perjury, I daclar. that the fact. I
.y knowledu. and bali.f.
!
.
IJ
GENERAL INFORMATION
1. FAILURE TO RESPOND WILL RESULT IN AN OFFICIAL TAX ASSESSHENT with applicable Int.,nt bU" on Infor.atlon
,ubII!tted by the fllUlnClal Institution.
Z. InherltlnCl tl. bec~' delinquent nlnt lanthl .ftar lhe decad~t'. dlt, of d..th.
S. A joint ~count I. t..~I. Iven though the d.c.d~t'. n... MI' edd~ II . ..ttar of convenl.nCI.
4. Account. (lncludlnt tho.. hlld bltw.en hu.band and wlf,) which thl ~.dent put In joint n.... within ona ~..r prior to
death .r. fully t..abl. .. t,M"I".
5. Account. ..tabl1Ih~ Jolntlv batween hU.b~ and wi'. lor. t~ one y..r prior to d..th .r. not ta.lbl..
,. Account. held by . d.cadent -In 'ruIl fa,. enothar or other. .r. t..~l. fully.
REPORTING INSTRUCTIONS - PART 1 - TAXPAYER RESPONSE
1. IlOCX A _ If the Infor..tlon ~ c~t.tlon In thl notlcl .r. corrtct and d.ductlon. .r. not bllnv cllllad, pl.cl ~ -X-
In block -A" of P,rt 1 of the .T..p.ye~ Re,pon'e~ ,ectlon. Sign two cople. ~ .ub.lt the. with you~ ch~k fo~ the .-ount of
h. to the halsta~ of WUs. of tM county IncUutlld. The PI Dep.rta..,t of hVWN. will Inu. ." offlcl.1 .........,t
(Fo~. REV-15'. EX) upon r.c.lpt of tM r.tu~n fro. the R.al.t.~ of Will..
Z. BLOC. B .. II tM ....t ,p.clfl.d on this notlu h.. b..., O~ will b. r.ported 8nd t.. paid wlth ttt. Pannulv."l. IntMr1tMC.
T.. R.turn filed by the dacad."t'. repr..entstlva, plac. an -x~ In block "I" of Part I of ~ ~Ta.p.y.r R..pon'.~ .actlon. Sign ~
copy Ilnd raturn to the PI O.part.."t of R.venu., luneu of Indl...ldu.l h.... O.pt 280601, Harrlsbura, PI 17111-0601 In tM
envelop. pro...ldlld.
J. ILOCl C . If the notlc. Infor.atlon I. incorract and/or deduction. ar. belna cl.l_ad. ch.ck block ~C* and co.pl.t. Part. Z and S
ace:r:!!", t., '.he Inl:trl.:ct1!t~~ bd:;.!. U;n b= ~eplM: ':"::! ::\....;=1.. ~~::: ..H:'\ :I~"H :n:c!'l. for t."1 IlllUa;n: of tax ~:J:leth ta tho R:al:tor
of Will. of the county Indlc.ted. The PA Gap.rteent of R....enue will I..ue an offlcl.l ........nt (Far. REV-IS.I EX) upon receipt
of the r.turn fr~ the R.al.t.r of Will..
TAX RETURN - PART 2 - TAX COMPUTATION
LIIE
1. Enter the date the ~count orlalnallY WI' l.tabIISh.d or tltl.d In the .8nn8r a.l.tlng at data of de.th.
NOTE. For a decedent dying aftar lZ/IZ/Us Accounts which the decedent put In joint n.... lIllthln one Cl) y..r of de.th a"
taxlbl. fully.. tran.f.r.. However, ther. I. an ..clu.lon not to a.c..d 'S,OOO p.r tr.".f.r.. r.osrdl... 0' the ....Iue of
the ICCCM.l'\t or the nutlbar a' KCCU'lt. held.
If , doUble s.t.rlak C..) 8PP8sr. befor. your flr.t n... In the addr... portion of thl. notlc., the .s,aao a.clu.lon
.Ir.tcb he. bHlt deducted frOll the KCCU\t btltnc:e .. reportlld by the flnencltl In.tltutlon.
Z. Enter the total balMCa of tha KCCU'lt Including Inter..t accrued to the d.ta of d.ath.
:5. The perc..,t of the acCOU"lt that It taxlable fo~ .ach .urvlvar It at.,.IMd .. followlI
A. ThII percent taxable fo~ joint ....ts ..tlablhhed eo,. tNn _ y..r prior to the d-=adent'. dNthl
1 DIVIDED IV TOTAL NUMBER Of
.JOINT OWNERS
~-.pl., A Joint ....t ~-ol.t.~td
DIVIDED I't TOTAL NUMIER OF X 100 . PERCDCT TAXAlLE
SURVIVIHC JOINT OWNERS
In the n... of the d.cld.nt Ilnd two othe~ parton..
1 DIVIDED I't S (.JOINT OWNERS) DIVIDED IV Z CSURVIVORS) . .167 X 100 . 1'.7% nAXAIlE FDA EACH SURVIVOR)
I. The percent t..abl. for ....t. cn.t.. within OM ya.r of tM d-=.d..,t'. de.th or eccOU1t1 owntld by the dec.dent but held
In tru.t fa~ WIOther IndlvlduaU.1 Urult baneflc:1.rte.),
I DIVIDED IV TOTAL HUHIER OF SURVIVING JOINT
OWNERS OR TRUSt BENEFICIARIES
X 100 . PERCENT TAlC&ILE
E.-.pI.1 Joint account raal.tared In the n... of the d.c.dant end two oth.r per.on. and ..tabll.h.d within on. y.ar 0' d..th by
the dMedlnt.
1 DIVIDED IV Z (SUNIYORS) . .51 X 110 . 5a;( naxAlLE FDA EACH SURVIVOR I
,.. TM..aunt subject to t.x Cllna 4) It d.tar.INd by eultlpJylna the account b.lan=- Clln. l) by the p.rcent ta.llbl. UI". SJ.
5. Ent.~ the tot.l of the dabt. and deduction. II.ted In P.rt S.
6. fhI; MOUnt ta.abl. (11". ,) It d.t.nln.d by .ubtr.ctl"" the d.."tr and ri.ductJon. UI... 5) fro. tha NOunt 'UbJact h t.. Cline 4).
7. Ent.r the ~roprl.t. tax ~.t. CII". 1) .. det.r.ln.d below.
A. Fo~ d.ta. of de.th occurring .ft.r 6/10/''', the t.. rat.. fa~ t~an".r' to .pou..' ar. a. followll
1. Oat.. of de.th on or .ft.r 7/1/94 and before 1/1/'S the r.ta I. S~.
Z. Oat.. 0' d.eth on or .ftar 1/1/'5 trtn.f.r. to .pou... .111 be t...d .t O~ ta. r.t..
Nat., Fo~ d.tal of d..th prior to 7/1/94 transf.r. to .pou... .r. t..abl. at 6~.
I. Tran.f.r, to 11"..1 d..ctndant. Includlna fath.r, eother, .on, d.ughtar, arandchlldren, .on-In-Iaw.
dauoht.r-In-Iaw, .tepchlld 8nd thalr I..ue .r. t..llbl. at .1. parcant C6%1.
C. Tren.f.r. to .11 other. Includlna broth.~, .Ist.r, unci., .unt, nephew and nlace .r. ta.abl. at fifteen p.rcent CI5X).
D. If you ~ the tax r.ta, pl.... .paclfY your r.l.tlon.hlp to the d.c.dant In thl .r.. provided.
.. The ~t of t.. dUe Ulna I) II detar.IMd by ..,Ulphlna tht .-ount t...bl. Ulna 61 by the tax rat. Clln. I).
CLAIMED DEDUCTIONS - PART 3
DEBTS AND DEDUCTIONS CLAIMED
AIlowabl. dabt. and deduction. ar. d.t.r.ln.d .. follow'l
A. You 1-o.lly ar. rISPOn.lbl. fo~ p.y.ent, o~ the ..tlt. Subject to adalnl.tr.tlan by . par.onal rapr.lSnt.tl.... I. In'Ufflclent
to PlY the deductlbl. It....
I. You actually p.ld the dabts Ift.r d..th of the decedent and can furnllh proof 01 pay.ant.
C. Dabt. beIng cl.l.ad .u.t be It.alled fully In Part S. I' ~ltlDn*1 IP.C. I. needed. u.. pl.ln ptpt~ I I/Z" . 11~. Proof of
paye."t NY be reque.t.d by the PA Depart...,t of R.venut.
TAXPAYER ASSISTANCE
IF YOU NEED FURTHER INFORMATION OR ASSISTANCE, CONTACT ANY
REGISTER OF WIllS. PA DEPARTMENT OF REVENUE DISTRICT OFFICE
, OR'CALL THE BUREAU OF INDIVIDUAL TAXES. TAXPAYER INQUIRY UNIT IN
HARRISBURG AT (717) 787-8327. TOO' (717) 772-2252 (HEARING IMPAIRED ONLY)
-- -. .- - ... .~.
~---------------~--------------------------------
"
"
1~~"082543,COr.wONWEALTH OF PENNSYLVANIA
Fii~~'m~d~:\';'OF'ICIAL RECEI" . p~:~:~:'~: I~~:~~T~NCE AND ESTATE TAX
ACN
~ ASSESSMENT r:'I
RECEIVED FROM: II CONTROL iii
NUMBER
*'
AMOUNT
COLLEEN ~ POWERS
8 SUSSEX ROAD
'1':1160:198
_eo. 7:1
CAMP HILL, PA 17011
'-IOID"'"
ESTATE INFORMATION,
IJ:II FilE NUMBER
li 21-1996-0064
IJ:II NAME OF DECEDENT (lAST)
~ DOUGHERTY WILLIA~
II DATE Of PAYMENT
EJ POSTMARK DATE
COUNTY
CUMBERLAND
DATE Of DEATH
SSN
(FIRST)
H
189-09-1296
(MI)
SEAL
I1RS ANNE L DOUGHERTY
COLLEEN ~ POWERS
CHECK" :1190
m TOTAL AMOUNT PAID
,
, i
\ I '
RECEIVED BY 'j I ,.,
.eO.7:1
SI<
REMARKS
REGISTER OF WILLS
"
"
I .... ".,' ....
I ~GN'At~. . .-
MARY C. LEWIS' /) ! '.1/ /'..'
REGISTER OF WILLS
--------------------------------------------r-~-~~
,.. i .... ....
.
.
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...
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11
--_-""':""--~..JJ
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teneri
To fulflll "" .....Ir..,t. of SeGUon 1141 of the I"".rlbnoe WId Eltate To Aot, Act II of 1"1. (11 P.I.
IecIUon 1141).
PA'nmfT1
o.bclh tho t. "rUon of th.. NoUn WId __It ..lth ",," ~t to u. R..llt.,. of 'UU. printed on the
r....... .Ict..
.. .... chedl Ot' ..-y orde,. payllblo tOI MinSTER Of' WULI, ACIlfT.
AU ~to r_lwed ..11 flr.t be ...UIld to MY Intor..t .....Ich ., bra ..., ..Ith any ,._Indo,. ...UIld to the ta.
MF1.IID (ClUI , refund of 0 tax credit, .....Ich .... not ,.......tocl on tho tu r.turn, -v be r....ted by COIIP..U.... on -",U08Uon
for hhN of Pwwloylwnl. Inhlrlt... and Eat.te Tax- UIEV-UlSJ. ....Ucotlon. .r. IWIiUIbI. .t tho afflc. of
the 1..I.to,. of 'IIU., In)' .f tho ZJ ........ alat,.l.t Off I.. 0,. by ceUlne tho .,.1.1 14-hou,. .,....,.Ine .....In
nuIbor. fer ...... orderl,.1 In Pwwloylv.d. 1.......:I6I-IOS., autlldl ""'oylVWIla end ..Ithln local
Hlr,.llbur...... (717) 7.7-.IM, TDDI (717) nl-usI (....rlng 1...lrod On.,J.
DlJl:CTIOMII "'" perty In Int.,...t not ..U.fled ..Ith the ..,..I.....t, aUownce or dl..UDWnCI of ......Uon. or ........t
of t.. (lnaludl.... dllCOU"lt 0,. Int.ra.U .. ..... on thh Notice -v _JlGt ..Ithln .Idy (&OJ clay. of rOOlI,t of
tit" MoUn QI
...""Itt... P,.ot.1t to the PA ....,....,t of IIIVIf'IJO, Ioerd of .....h, Dept. 2IUll, ...,.,.Isbu,.., PI 17U'''lIll, a.
...I.U,. ta hwtl tho ..u.,. dlt.,..IMd .t tho ..It of tho aocount of the ,.,..onal rapr.aontaUv., aR
.......1 to the a,."...... Court
AIIIUN-
IIWTIW
CORRfCTtONlI
'eatuol .,.,..,.. dhcov.r_ on thl. .........,t Ihould be addr...ecI In ..rlUne tal Pi Dopert..,t 0' Ravenue,
Iur--.. 0' Indlvl...l T...., ATTNI POIt A....~t R.."I... Unit, DEPT. ZI"Il, Hlr,.hb",.., PI 17U'-llIl
Phone (717) 7.7-61IS. ... PIlI J 0' tho bookl.t -In.truetlon. fo,. 1"".,.ltanoo Tax I.turn 'or a R..ldont
Dooodont- (REV-1S01J for en 1XP1~tlon of ~lnl.t,..tIYllr corraot.la arror..
DIICOUNTI
If ." tax due I. ..-Id ..I thin th,... (S) c.l..-,. __tho .ftlr ..,. docodInt'. _th, . five percant (IXJ
dllOOUnt of tho t.. peld I. .U""'.
IIlTDIEITI
Int.r... II chi...... boIlmlne ..Ith flrat doy of dollnquMOy, 0,. nine ttJ .-tth. and _ UJ _
fr. tM dIIto of doIIth, to tho dat. of P.....,t. lu.. .....Ich boc-. doU".,.,t before ~ry 1, 1911
boor Int.,...t .t the rat. of ... (6):) parcont po,. ..... CII1cul.ted .t . dilly ,..t. of .101164.
All t.... .....Idt .,... dlU,..,.,t on a,. oft.~ ~r)' 1, 1HI ..111 boo,. Int.r..t .t I rat. .....Ich ..Ill wry fr.
col..-,. """ to cel...... yoar ..Ith thot rat. amouncocI Q the PI Dope,.bont of Ravenue. 11M ...lIco11lo
Int.r..t ,..t.. fo,. 1"1 thrOUlh 1'" .,..1
UIr Int'l'..t bt. hllv rnt.r..t 'Mltar XIIr Intor..t R.t. D.llv rnto....t "l4IIter
1911 lOl .DUM' 1911 n .000r47
ltu 10 .11041' 1'11-1"1 III .000311
1914 III .OOOSOI I"' n .101l47
ItIS ISlf .000356 I"S-ltM n .0Ult!
1- lOX .100174 I"S-I_ n . DOU"
....Intor..t I. calcullt_ .. fallOt1"
IIlTERElIT . IALAHeE OF TAll UIlPAID X KUKlER OF DAYI DELINQUENT X DAILY IIlTERElIT FACTOR
....Any MoUe. 1..,,_ oUo,. the tu ....... doU".,."t ..111 r.flaot ... Int.r." colcul.tlon to flftoon enJ _.
beyond tho doto ., tho .....~t. If poyaont II ..... afto,. tho Int.rllt cooput.tlon dlt. Ihowt on tho
MotlCI, edcUtlonal Intorllt ...t be colcul.ted.
~
15-86-;}.
C' j
t\
,/
REY-l!141 EX AFP (lZ-9!1*
aMOIWUlTH (II' PENHlYlVMIA
P[PUTftDfl' at RE:VOIJE
IlIIUU 01 INDIVIDUAL 1mS
DUr. II"'.
HIRIIIIURO, PI 17.r.-'.'.
ESTATE OF DOUGHERTV
FILE NO. 21 96-0064
"OTICE OF IIflIlJIITAHCE TAX
APPRAISEIIENT, ALLDMA"CE OR DISALLOMAHCE
OF DEDUCTIO"s, AIID ASSESSIIEIIT OF TAX 0"
JOINTLY HELD OR nUST ASSETS
DATI 03-25-96
WILLIAM H OATE OF DEATH 10-23-95
COUNTY
CUMBERLAND
S.S/D.C. NO. 189-09-1296
ACN
95160599
COLLEEN M POWERS
8 SUSSEX RO
CAMP HILL PA 17011
REMIT PAYMENT TOI
REGISTER OF WILLS
CUMBERLAND CO COURT HDUSE
CARLISLE, PA 17013
'-'nt R_I ttlld
CUT ALONG THIS LINE ~ RETAIN LOWER PORTION FOR YOUR RECORDS ~
Rifv:islri-Ejf-AFii-liz-:9'i------------------------------------------------------------------------------------
NOTICE OF INHERITANCE TAX APPRAISEMENT, ALLOWANCE OR DISALLOWANCE OF
DEDUCTIONS, AND ASSESSMENT OF TAX ON JOINTLY HELD OR TRUST ASSETS
DATI 03-25-96
ESTATE OF DOUGHERTV
FILE NO. 21 96-0064
TAX RETURN WAS.
WILLIAM H DATE OF DEATH 10-23-95
CDUNTV CUMBERLAND
S.S/D.C. NO. 189-09-1296
(X) ACCEPTED AS FILED ( ) CHANGED
JOINT OR TRUST ASSET INFORMATION
ACN
95160599
ACCOUNT NO.
5130093834
FINANCIAL INSTITUTIDN. PNC BANK
TVPE OF ACCOUNT. (Xl SAYINGS ( ) CHECKING ( ) TRUST ( ) TIME CERTIFICATE
DATE ESTABLISHED 01-01-Bl
Account B.hne.
P.rc.nt T.x.bl. X
Amount Subj.ct to T.x
D.bt. .nd D.duction.
T.x.bl. Amount
T.x R.t. X
T.x Du.
TAX CREDITS I
PAVMENT
DATE
01-25-96
RECEIPT
NUMBER
AA082542
8,678.89
0.166
1,446.51
.00
1,446.51
.06
86.79
NDTE. TO INSURE PROPER CREDIT TO
YOUR ACCOUNT, SUBMIT THE
UPPER PORTION OF THIS NDTICE
WITH YOUR TAX PAVMENT TO THE
REGISTER OF WILLS AT THE
ABOVE ADDRESS. MAKE CHECK
OR MONEV ORDER PAVABLE TO.
"REGISTER OF WILLS, AGENT."
DISCOUNT (+)
INTEREST (-)
.00
AMDUNT PAID
86.79
86.79
.00
.00
.00
TOTAL TAX CREDIT
BALANCE OF TAX DUE
INTEREST
TOTAL DUE
. IF PAID AFTER THIS DATE, SEE REVERSE FOR CALCULATION OF ADDITIONAL I"TEREST. ·
I IF TOTAL DUE IS LESS THAN .1, NO PAYHENT IS REQUIRED.
IF TOTAL DUE IS REFLECTED AS A "CREDIT" I CRI, YDU HAY BE DUE A REFUND.
SEE REVERSE SIDE OF THIS FOAN FOR INSTRUCTIONS. I